Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00360
T L G AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S102BCO2003
Jurisdiction: Tigard
Site address: 10700 SW FONNER ST
Project: SAKHITAB Subdivision: NORTH TIGARDVILLE ADDITION Lot: 24
Project Description: Replacing 50 ft.of water service. An electrical permit may be required if house grounding is affected.
Contractor: EXCELLENCE PLUMBING LLC Owner: SAKHITAB, HOMA
8269 SW CIRRUS DR 10700 SW FONNER ST
BEAVERTON,OR 97008 TIGARD,OR 97223
PHONE: 503-643-3459 PHONE:
FAX: 503-643-2815
FEES
Quantity Description Date Amount
50 If Water Service 10/15/2013 $62.54
Specifics: 1 12%State Surcharge- 10/15/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment- 10/15/2013 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $81.20 1
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Oct 11 13 04:09p Excellence Plumbing,LLC 503-643-2815 p.1
Plumbing Permit Applicat� - ...
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FOR OFFICE USE ONLY
Site Utilities -ft_(�,�'' ri "
Received Permit Nc. / ( -
City of Tigard p ¶ Han Review ' )3 v -
n L3 L25 SW Hall Blvd.,Tigard,OR 9 f 1 4 2013 Diat Rya yew C)LM7 Permit Nn, �� 1/j�,,,\�/�
C Phone: 503.718,2439 Fax: 503.598.1960 DateiBy W
(I Date Ready/By Jtoic: H See Page 2 for
Inspection Line: and-o 9.4175 ,n.V ._ ii„,_ 5 Supplemental Information
T IGARD itilcrnaC µ'ww.iigarJ-or.g�v �q � t"61.��!d�'%t �x[tiai�ti{shod: _��
_ 4KG 1 ., 'I". �,,: FEE* SCHEDULE
TYPE OF�INVIIK. `( ,, ' t
. For special information use checklist.
❑New construction ❑Demolition Description I Qty. I Es. I Total ,
®AdditionraLteration,replacement ❑Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
J
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 437 78
SFR(2)bath
Co mine rciallindustrial 500.32
® 1 and 2-Gamily dwelling ❑ SFR(3)bath -
Accessory building ❑Multi-fatnil}' Faelt additiatal balh.7 itches 25.32
❑ Master builder
❑Other: Fire sprinkler( sq.it.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:10700 SW Filmier St swell,leach line-or trench drain 18.76
Clty/StateiZIP:Tigard,OR 97224 Footing drain(no.Iin•-arft.:_) Page 2
Project name:Valid Manufactured home utilities 50.03
Suitc;bldg.apt.no.: J -
Ivianitoles 18.76
Cross slieet'd.rections to job site: 1R 76 ,1 /
Rain dram connector (Jt �
Storm sewer(no.linear it: ) Pape 2 �t}1\�1
Water service(no.Linear ft.:50) I Page 2 62.54 �q'
Subdivision: I Lot no.: - Fixture or item: _
Backllow prevenler 31.27
'fax map+tweet l no.: -
Backwater valve 12.51
DESCRIPTION OF WORK: i
Clothes washer 25.02
Replace water service Dishwashe-. 25.02
Drinking fountain 25.02 i
Ejeclorslsump 25.02
Expansion tan): J 12.51
❑ PROPERTY OWNER ` ❑ TENANT 25.02
Fisturo•sewcr cap
Name: Figur draitt.'floor sinkibub 25.02
Address: i Garbage disposal 25.02
Gitv;Statc!Z:P:
Hose bib 25.02
Ice maker 12.31
?hone:( ) I Fax:( ) -
❑ APPLICANT ❑ CONTACT PERSON Interceptor greasetrap
I Page 2
Medical gas(value:$ ) 1 25.02
Business name: Primer 12.51
Contact name: Roof drain(conincrcial) 12.51
Address: Sink/basin/lavatory 25.02
Citvl5tate!Z[P:
Solar units(potable water) 62.54
Tab/shower/shower pan ;2.51•Phone:( ) Fax: ( ) Urinal 25.02
E-mail: water closet 25.02-
CONTRACTOR heater 37.52
Business name: Excellence Plumbing,LLC Water pipiny'DW V 56.29
Address:8269 SW Cirrus Dr.
Other: 25.02
Subtotal
City,State/2.IP:Beaverton,OR
Minimum permit fee: 572.50 72.50
Phone:(503)643-34:719 l Fax:(503)643-2815
Plan review (25%of permit fee)
CCB Lie.:175768 Plumbing Lic.no.:ltPR344 State surcharge([2%of permit fee) 8.70 /
Authorized signature: �,j_ TOTAL PERMIT 1'LE 81.20 ✓
This permit application expires If a permit is not obtained ,t1htn 180 days
' f Print name:Shelly Eugenio Date:10-11-2013 after It has been accepted as complete.
"Fee:nethodolca set by Tn-County Building lnd.tstry Service Board
t.,outdas'.r.nrin;,e.nrn-t:ennivtppArc 15:01!0') 440.46161114'OZIC(NMIl1